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Purpose: There are approximately 8 million people with trachomatous trichiasis globally; in the year 2009, less than 160,000 people had surgery. These numbers are too low in order to achieve the goal of elimination of blinding trachoma by the year 2020. Task shifting approaches have led to the training of general nurses in trichiasis surgery in eastern Africa. The overall aim of this study was to determine the attrition and productivity (and the factors associated with productivity) of trichiasis surgeons in Kenya, Tanzania, and Malawi. Methods: A 3-year cohort study of trichiasis surgeons. Results: The overall response rate was 86%. Defining high productivity as 50+ operations per year per surgeon, only 16.1% of the trichiasis surgeons were highly productive. Among the surgeons, 27.9% were no longer at their site and ceased providing surgery (attrition) over the 3 years of study. High productivity was associated with having been trained by an experienced trainer, supervised by a clinical officer, having more than three surgical sets, and having an outreach program. Conclusion: Attrition of general nurses trained in trichiasis surgery was high. Surgical productivity of trichiasis surgeons remained too low. It is likely that other approaches are needed to address the burden of trichiasis in the three countries. In terms of recommendations, training of trichiasis surgeons should be done in a 'package,' including a plan for provision of surgical equipment, continuous support and supervision, and outreach. [ABSTRACT FROM AUTHOR]

Henneguya azevedoi n. sp. is described from the piava ( Leporinus obtusidens). Between 2005 and 2007, 60 fish were collected from the Mogi-Guaçu River near Cachoeira de Emas Falls located in the municipality of Pirassununga, state of São Paulo, Brazil. A total of 70% had plasmodia of the parasite. The plasmodia were white, spherical, and measured 40-200 μm in diameter. Histopathological analysis revealed that the development of the parasite was intralamellar and caused stretching of the epithelium, with accentuated deformation, as well as compression of the capillary and adjacent tissues. Ultrastructural analysis revealed that the wall of the plasmodium was a single membrane in direct contact with the host cells and contained pinocytic canals that extended into the plasmodium. The development of the parasite was asynchronous, with the earliest stages at the periphery and mature spores in the central region. Mature spores were elongated in the frontal view [mean ± standard deviation (range)]: 45.2 ± 0.6 (45.0-47.0) μm in total length, 10.0 ± 0.07 (9.9-10.2) μm in body length, 35.6 ± 0.9 (34.9-36.5) μm in caudal process length, and 4.4 ± 0.4 (4.0-5.0) μm in body width. The polar capsules were elongated and equal in size: 3.8 ± 0.3 (3.5-4.0) μm in length and 1.0 μm in width. The polar filaments were coiled in six to seven turns and perpendicular to the axis of the capsule. Scanning electron microscopy revealed smooth valves and a conspicuous rim around the spore body. This is the first time that a myxosporean has been reported in L. obtusidens. [ABSTRACT FROM AUTHOR]